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Friday, June 29, 2012

FDA Bill Grants Power to Search Overseas Rx Plants

WASHINGTON - A Food and Drug Administration bill designed to increase inspections of foreign drug factories, while also speeding approvals of new drugs at home, is headed to the president's desk after an overwhelming approval in the U.S. Senate.
The Senate approved the must-pass piece of the legislation by a vote of 92-4, and President Barack Obama is expected to sign it into law within days.
The core of the bill is critical to the FDA: It bolsters the agency's budget with billions of dollars in drug industry fees for scientists who review new medicines. For the first time, generic drugmakers will pay review fees to speed the approval of their products. Branded drugmakers have paid those fees for 20 years.
Lawmakers seized on the legislation to address recent concerns about the safety and quality of prescription medicines, especially those that are imported. The bill also gives the FDA new tools to fight counterfeiting and drug shortages, which have made headlines in the past year.
"This legislation will help bring critical drugs and medical devices to market faster, protect patients from drug shortages and manufacturing problems, and enhance the availability of low-cost generic drugs," said Sens. Tom Harkin, D-Iowa, and Mike Enzi, R-Wyoming, who guided the bill through the Senate.
Public health experts say the most significant changes for consumers involve how FDA inspectors oversee foreign drug manufacturing facilities.
For more than 70 years, the agency has focused its inspections on U.S. factories. But most companies have moved their operations overseas to take advantage of cheaper labor and materials. Between 2001 and 2008 the number of U.S. drugs made outside of the country doubled, according FDA figures.
The bill passed by Congress would drop a requirement that FDA inspect all U.S. drug factories every two years and let it focus on foreign facilities, which it now typically inspects every nine years. The new bill requires that FDA inspectors target the most problematic manufacturing sites, regardless of whether they're in the U.S. or overseas.
"This legislation will, for the first time, enable the FDA to regularly inspect foreign drug manufacturing facilities, which supply 80 percent of the ingredients in our medications," said Allan Coukell, director of the Pew Charitable Trusts' medical programs
The risks of unchecked foreign drug manufacturing hit home in 2008, when hundreds of U.S. patients suffered allergic reactions — some fatal — to a blood thinner imported from China. An FDA investigation concluded the drug had been contaminated, to reduce costs, with an ingredient that mimics the blood thinner heparin.
The bill would raise the maximum prison sentence for drug counterfeiting to 20 years, or $4 million, from just three years or $10,000, under current law.
Despite months of negotiation, the bill does not include a national tracking system, which public health advocates say is critical to weeding out counterfeit pharmaceuticals from the U.S. supply chain. Lawmakers said they couldn't bridge longtime disagreements between the FDA and drugmakers over the scope and cost of the system, which would track shipments using electronic codes.
The legislation's underlying purpose is to renew, through 2017, a program under which drugmakers pay the FDA set fees for the review of new products. Since it first passed in 1992, the Prescription Drug User Fee Act has allowed the FDA to hire hundreds of additional scientists in return for meeting certain performance goals.
Under the new bill, the FDA would collect $6.4 billion in fees from companies over five years beginning in 2013. About $1.8 billion, or nearly 30 percent, would come from new fees, including the first to be paid by generic drugmakers.
Whereas most new drugs are reviewed in 10 months, the typical review for a generic drug takes over 30 months. The FDA has a backlog of more than 2,700 generic drug applications awaiting review, according to the Generic Pharmaceutical Association. The new fees will be used to hire more scientists to speed up clearance of generic drugs.
The legislation also renews a similar program covering medical devices.
Senators hailed the legislation as a rare example of cooperation between Republicans and Democrats, but the fee agreements at its heart had almost nothing to do with Congress.
Those arrangements were worked out during more than a year of closed-door negotiations between the FDA and industry groups. The portion of FDA's drug review budget that's underwritten by industry has steadily increased since 1992 and is now more than 60 percent.
Consumer advocates complain that the agency has become too dependent on the companies it regulates. They say they were shut out of the discussions.

http://www.startribune.com/business/160442335.html

New Mexico Tightens Rx Drug System

Seeking to combat a growing epidemic of prescription drug abuse in New Mexico, the state Board of Pharmacy voted Thursday to strengthen an existing monitoring program that tracks drug prescriptions, who dispenses them and under what circumstances.

Other rule changes adopted by the board, which will go into effect later this year, will require additional training for pharmacists on how to use that monitoring system, limit the supply of drugs prescribed in certain situations and tighten language regarding penalties for anyone lawfully allowed to dispense prescription drugs who withholds or falsifies information going into the tracking system.

"We're accomplishing great things by educating pharmacists," Danny Cross, a board member and pharmacist, said during a well-attended, two-hour hearing Thursday at the board's Albuquerque headquarters. "This is not punishing pharmacists. This is to educate pharmacists, practitioners and patients ... to help control this drug abuse problem."

Over the past decade, New Mexico has experienced a spike both in the number of pills being prescribed and the number of drug overdose deaths reported. From 2001 to 2010, the sales of opioid pain relievers rose by 131 percent in the state, from 489,809 grams to 1.13 million grams, according to the state Department of Health. Meanwhile, over roughly the same period, the state's drug overdose death rate increased by 79 percent -- from the 261 people who died in 2001 to the 468 who lost their lives in 2010.

The epidemic, of course, is not confined to New Mexico. Nationwide, the National Survey on Drug Use and Health estimated that in 2010, 7 million people used prescription drugs nonmedically.

But New Mexico's rate of drug overdose deaths is the highest in the nation.

Even some of the state's pharmacists don't understand the size of the problem, Dale Tinker told board members Thursday.

"It's a lot bigger issue than I think they thought," Tinker, a lobbyist for the New Mexico Pharmacists Association, said.

Tackling the prescription drug abuse problem is complex because it involves multiple challenges. Emergency rooms might see addicts looking for their next fix or dealers trying to corral a new supply, but they also come into contact with patients who want to get off the drugs and don't know where else to turn.

One of the challenges is to ensure that those who are handed a white bag with a bottle of pills inside are the people who truly need it. Another is ensuring that those who hand the prescribed drugs to individuals have access to up-to-date information that the prescription is appropriate.

The rules adopted Thursday represent an attempt to address those problems, mostly by ensuring pharmacists and pharmacist interns are better armed with information on how to prevent abuse and stop addiction before it starts, officials said.

One of the changes would give New Mexico's pharmacists the ability to request from the state's prescription monitoring system a report detailing the past year of a patient's history if he or she exhibits signs of potential abuse or misuse of opiate drugs or if the prescription order is from a dispenser with whom the pharmacist is unfamiliar.

Also under the new rules, practitioners including doctors, dentists, veterinarians, pharmacists and certified nurse practitioners would have to register and train for the state's monitoring program when they complete their controlled-substance registration.

That electronic database gives doctors and pharmacists access to a patient's prescription-drug history. Providers update the information at least every seven days -- an improvement over the monthly updates that were previously all that was required.

"It's a message from the board," said Bill Harvey, the Board of Pharmacy's director. "It's about professional expectations."

The board also voted to require that any controlled-substance prescriptions that go directly to a patient could not be refilled before 75 percent of the days have passed since the prescription was filled, unless a doctor approves the refill. Similarly, prescriptions that go to a patient indirectly, such as through a mail-order service, couldn't be refilled until 66 percent of the days in a 90-day supply have gone by, or half of the days in a 30-day supply, unless a doctor authorizes the refill.

Another change would limit new over-the-phone prescriptions for some controlled substances to a 10-day supply that cannot be refilled. Currently, a phone prescription for those drugs can be refilled up to five times in six months.

Board members seemed intent on adopting the changes Thursday despite potential obstacles.

"We're trying to get things in place sooner rather than later," board member Buffy Saavedra said at one point when someone in the audience asked a question that appeared not to be answered in the proposed rules.

At another point, the board learned that a proposed change would bar the state from qualifying for future U.S. Drug Enforcement Administration funding for the state's prescription monitoring program.

The change under consideration would allow individual pharmacists to access and use the state's prescription monitoring program instead of circumscribing access only to pharmacies, which the DEA requires for a state to qualify for certain types of funding. Many pharmacies employ more than one pharmacist, officials pointed out Thursday. And by having individual pharmacists register to use the system, New Mexico officials believe the state can better track potential abuse.

"This is a big enough problem" that the board should go ahead with the change despite the potential loss of future federal funding, pharmacy board chairman Richard Mazzoni said.

http://www.hispanicbusiness.com/2012/6/22/new_mexico_tightens_prescription_drug_system.htm

Witness Describes Kins Addiction to Rx Drugs

Elissa Ogle begged her brother-in-law to stop using prescription drugs. She took his pills and locked them in a box under her bed. She hid the knobs on the kitchen stove after he fell asleep while cooking, intoxicated by his narcotic pain medication. “Steven, stop, please, stop!” Ogle said she told her brother-in-law, Steven Ogle. She recalled him responding: “My doctor prescribed to me, my doctor prescribed to me.” Ogle testified Tuesday at a preliminary hearing to determine whether there was enough evidence for Dr. Hsiu-Ying “Lisa" Tseng to stand trial on second-degree murder charges in connection with the overdose deaths of Steven Ogle and two other men. Tseng has pleaded not guilty. In the 11th day of testimony in downtown Los Angeles, Ogle described visits to Tseng’s storefront clinic in Rowland Heights, where she drove Steven three times from Palm Desert before he died of an overdose in 2009 at age 24. The waiting room, she said, was filled with young patients who “looked drugged out or sedated…like they took a lot of medication or they smoked something.” During one visit, Ogle testified, she went into a restroom while waiting for Steven. She described the room as “smoky” and said there was a needle in the garbage can. She left the office and waited for her brother-in-law in her car because she was so disturbed, she said. Prosecution witnesses have said Tseng prescribed her patients addictive narcotics despite warning signs that they were abusing drugs. Prosecutors allege that Tseng knew her prescribing practices were harmful and that she knew patients were dying under her care. When Deputy Dist. Atty. John Niedermann showed Ogle a copy of one of Steven’s prescriptions from Tseng, Ogle broke down in tears. The last time she saw Steven alive –- after he had been fighting with family members over his addiction and his visits to doctors -- he had a pill bottle in his pocket, and she could hear his pills rattling, she said. Tseng also is charged with the overdose deaths of Vu Nguyen, 28, of Lake Forest, and Joey Rovero, 21, an Arizona State University student from San Ramon, Calif. Testimony is expected to continue Wednesday.

http://latimesblogs.latimes.com/lanow/2012/06/witness-recalls-kins-addiction-to-drugs.html

Sunday, June 24, 2012

Rachel Maddow covers New Michigan Policy

Hospira Drug Recall

The U.S. Food and Drug Administration (FDA) recently announced the nationwide voluntary recall of a lot of Hospira, a hydromorphone hydrochloride injection. According to the announcement, this recall has been initiated due to two reports of single drug delivery cartridges containing more than the 1 mL volume of the labeled medication.
These Hospira cartridges are part of the Carpuject Syringe System, which consists of prefilled glass cartridges that are loaded into a syringe holder to deliver the drug. This system is intended to provide an easy, safe, convenient, and time-saving method of delivering this medication.
However, the FDA explains that opioid pain medications such as hydromorphone have life-threatening overdose consequences which include the following:
  • Respiratory depression-slowed or suspended breathing
  • Low blood pressure
  • Reduced heart rate and circulatory collapse
The faulty lot was distributed from September to October of 2011 and has the lot number 07547LL. The expiration date for this lot is July 1, 2013. The medication was first distributed to wholesalers and some hospitals in the following locations: Alaska, Alabama, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Florida, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Washington, and Wisconsin.
Although the drug’s manufacturer, Hospira, Inc., says they have not yet received any adverse event reports related to this lot defect, they have begun an investigation to coincide with this recall. Through this investigation, the manufacturer hopes to determine the root cause of this defect, as well as determine any preventative actions that need to take place.
The recall announcement explains that anyone who experiences problems that may be related to this medication is encouraged to contact their physician or healthcare provider to report these issues. Furthermore, anyone possessing this medication is instructed to stop using or distributing it and to quarantine what they have.
Individuals are then instructed to call Stericycle at 1-888-912-7093 to arrange the return of the product. The FDA explains that replacements from safe lots of this medication are available to customers and can be received by sending their DEA 222 form to Hospira, 1635 Stone Ridge Drive, Stone Mountain, GA 30083.

http://www.drugalert.org/recalls